CHILDHOOD EPILEPSY WITH OCCIPITAL PAROXYSMS: DIFFICULTIES IN DISTINCT SEGREGATION INTO EITHER THE PANAYIOTOPOULOS OR THE GASTAUT SYNDROMES

Objectives: Childhood epilepsy with occipital paroxysms was rigidly segregated by the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE) into two separate syndromes with different predominant seizure types: early onset (Panayiotopoulos type) consisting of prolonged infrequent, nocturnal seizures, accompanied by eye deviation and ictal vomiting and the late onset Gastaut type with short diurnal frequent seizures and visual ictal manifestations along with throbbing headaches.

Methods: The epileptic clinical manifestations and electroencephalographic data were analyzed in twenty eight patients with suspected occipital lobe epilepsy attempting to segregate them into either the early or late forms according to the ILAE classification.

Results: The EEG in 25 children demonstrated occipital epileptiform paroxysms compatible with the suspected epileptic syndrome. Of these, only 13(47%) could comply with the rigid criteria of either Panayiotopoulos or Gastaut types. The rest 15(53%) children presented with various mixed epileptic phenomena including short-lived epileptic blindness (3, 23%), vomiting (9, 60%), and adversive seizures (7, 47%).

Conclusion: In conclusion, despite present attempts to rigidly segregate childhood epilepsy with occipital paroxysms into two distinct epileptic syndromes, a high percentage of children still present with various mixed clinical phenomena. Therefore, clinicians should be aware of possible unique and unusual presentation of occipital lobe epilepsy.